Like Extended Health Benefits – only better! With our Enhanced Health Blends (EHB) plan members get coverage that mimics insured health and dental but there are no surprise renewals, and the plan sponsor controls the budget.
Also known as Administrative Services Only (ASO) or self- insurance, our EHB is a self-funded version of traditional health insurance. Instead of paying premiums to an insurer for benefits that may not be used, with an EHB the plan sponsor only pays for what plan members actually claim, plus an admin fee.
Plan members get the valuable coverage they expect, and the plan sponsor gets an affordable, flexible plan design that helps manage cashflow.
We work with the plan sponsor to design service maximums that limit risk, then do the heavy lifting to administer and reimburse claims. An upfront reserve is provided to pay claims. Plan members claim eligible medical expenses, just like under an insured group benefits plan. Funds are deducted from the reserve to reimburse members. A simple and transparent fee is applied to reimbursed claims.
Plan sponsors can add stop-loss insurance to limit exposure to catastrophic health claims but strategic plan design and mitigation tactics for catastrophic health issues can facilitate the same outcome.
If claims exceed forecasted budgets, the plan sponsor is responsible for the deficit. If claims are less than anticipated, the plan sponsor keeps the surplus.
Details
Minimum Group Size
15
Fees
- 18% on reimbursed claims
Advisor Compensation
6% but variable (fee will change accordingly based on our 12% fee)
Eligible Expenses
Defined by the plan sponsor as part of plan setup. May include service maximums, co-pays, etc.
Unused funds at end of Benefit Period
There are no "unused funds" since plan sponsors are billed as claims are incurred. However, a plan sponsor reserve is held to pay future claims.
Unused funds when member leaves
Members have 30 days to submit claims.
Eligible Dependants
Determined based on plan sponsor guidelines